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CONTRIBUTION OF T2 * WEIGHTED SEQUENCE IN THE PATHOLOGY OF CEREBRAL SMALL VESSEL IN THE ELDERLY

NR24. CONTRIBUTION OF T2 * WEIGHTED SEQUENCE IN THE PATHOLOGY OF CEREBRAL SMALL VESSEL IN THE ELDERLY. S.BELABBES, S.BELASRI, S.CHAOUIR, T.AMIL, A.HANINE, D.BASSOU. Department of Radiology, Military Teaching Hospital Mohammed V of Rabat. Morocco. INTRORUCTION.

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CONTRIBUTION OF T2 * WEIGHTED SEQUENCE IN THE PATHOLOGY OF CEREBRAL SMALL VESSEL IN THE ELDERLY

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  1. NR24 CONTRIBUTION OF T2 * WEIGHTED SEQUENCE IN THE PATHOLOGY OF CEREBRAL SMALL VESSEL IN THE ELDERLY S.BELABBES, S.BELASRI, S.CHAOUIR, T.AMIL, A.HANINE, D.BASSOU Department of Radiology, Military Teaching Hospital Mohammed V of Rabat. Morocco

  2. INTRORUCTION Intracerebral hemorrhage in the elderly: • Is an important cause of mortality and neurological morbidity. • May be due to two main artériolopathies: 1 – Arterial hypertension (AHT): Fisher Lipohyalinosis 2 – sporadic cerebral amyloid angiopathy.

  3. Materials and Methods • Iconographic illustration of retrospective head MRI performed in patients treated for an acute or chronic, ischemic or haemorragic pathology, or an array of cognitive decline. • MRI with gradient echo sequence T2 *

  4. RESULTS • In T2 *: the appearance and distributionl of lowsignal intensity of brainparenchyma have allowed us to distinguish: • Punctatehemorrhage (PH) predominantin diencephalicregion, brainstemand the cerebellarhemispheres: lipohyalinosis (AHT). • Punctatehemorrhagein the cortico-subcorticaljunction.: Amyloidangiopathy

  5. DISCUSSION • the chronic pathology of cerebral small vessel causes a chronic ischemia in the territories concerned, source of brain dysfunction whose later expression is dementia • It includes several entities dominated by: • The arteriopathy of chronic arterial hypertension :patients under 55 years. • Risk of recurrent bleeding: 2%. • The amyloid angiopathy (AA): • Concerns elderly over 60 years. • Risk of recurrence exceeds 10%

  6. DISCUSSION • Chronic hypertension and amyloid angiopathy degrades and weakens cerebral artery walls small caliber by deposition of amyloid • causes them to break directly, or after formation of microaneurysms of Charcot-Bouchard

  7. DISCUSSION ChronicArterial Hypertension • deep topography: • On the perforating arteries • the diencephalon • the Basal ganglia • The posterior fossa • The pons • The cerebellum • more or less associated with a peripheral location at the junction of gray matter-white matter.

  8. A B MRI: T2 * sequence, axial section. Low signal intensity, predominantly in the diencephalic region (A), and in the cerebellar hemispheres (B).

  9. DISCUSSION AmyloidAngiopathy age over 60 years •lobar topography sustentorial, predominant in frontal regions • seat cortico-subcortical • respect for deep structures, white matter, cerebellum • frequent coexistence with arterial hypertension lesions.

  10. AmyloidAngiopathy T2 * MRI, axial section: Presence of low signal intensity in the cortico-subcortical junction.

  11. DISCUSSION T2*+++ • T2-gradient echo or T2 *, sensitive to magnetic susceptibility artifact. • Detects hemorrhages in the acute stage (deoxyhemoglobin) and chronic stage (hemosiderin), not detectable on conventional sequences or macroscopic examination.

  12. CONCLUSION T2 * weighted imaging 1-is essential for exploration of: • Encephalic vascular damage, acute or chronic. • Cognitive impairment. 2-It allows positive diagnosis of cerebral microhemorrhages 3-And according to the topographic distribution of microhemorrhages, can approach the etiologic diagnosis.

  13. BIBLIOGRAPHY 1-Lahutte M, Darbi A, Lévêque C, Cordoliani YS. Pathologie chronique des petits vaisseaux cérébraux et malformations vasculaires occultes: apport de la séquence de susceptibilité magnétique T2*. Feuillets de radiol,2006:46:3:182-190 2- Gere J, Minier D, Osseby GV, Couvreur G,Moreau T, Ricolfi F, et al. Epidémiologie des accidents hémorragiques cérébraux. J Neuroradiol 2003; 30: 291-7. 3- Lee SH, Kwon SJ, Kim KS, Yoon BW, Roh JK. Topographical distribution of pontocerebellarmicrobleeds. AJNR Am J Neuroradiol 2004; 25: 1337-41. 4- Roob G, Lechner A, Schmidt R, Flooh E, Hartung HP, Fazekas F. Frequency and location of microbleeds in patients withprimaryintracerebralhemorrhage. Stroke 2000; 31: 2665-9.

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